5280 Magazine – August 2019

AUGUST 2019 | 5280 | (^79)
the CDPHE, can’t be attributed to a single fac-
tor. Instead, he says, poor diagnosis, inadequate
treatment, the opioid epidemic, and unsafe sex
(perhaps fueled in part by dating apps) might
all share part of the blame. While HIV rates have not mirrored the
alarming increases of these other STIs, the diseases can be passed
along in the same way. Worse, says Dr. Ed Gardner, a Denver Health
infectious disease specialist, HIV transmits more easily in someone
who already has an STI. “From the clinical side,” Gardner says, “I
think the higher STI rates are somewhat concerning.”
Much like vaccine-preventable diseases have resurfaced in pockets
of the country (see: measles), HIV infections along the Front Range
could increase if the medical community and general public—espe-
cially those populations that are at a higher risk—don’t remain vigilant.
“We saw fairly steep declines through the late 1990s and into the
2000s, and that kind of leveled out and then ticked up a bit,” Shodell
says of Colorado’s HIV numbers. “We’re no longer decreasing; that to
me is a great concern. If we had continued on the trajectory that we
were on, we should be a lot lower in terms of new cases.”
DENVER HEALTH’S GARDNER understands, maybe as well
as anyone, why HIV hasn’t been eradicated in America,
despite the highly effective tools at physicians’ disposals.
In 2011, Gardner and a team of researchers developed
the HIV care continuum, a road map for how to effec-
tively treat people newly diagnosed with HIV. The
to the Mile High City for the National Lesbian
and Gay Health Conference. The group drafted
a historic document called the Denver Principles,
which reads, in part, “We condemn attempts to
label us as ‘victims,’ a term which implies defeat,
and we are only occasionally ‘patients,’ a term
which implies passivity, helplessness, and depen-
dence upon the care of others. We are ‘People
With AIDS.’ ” That document codified a strong
sense of advocacy and empowerment in the HIV
community early on, and it has continued ever
since. “This group of young adults were really
quite vocal in their health care,” Greenberg says.
“Their proactiveness has changed the way medi-
cine is practiced today.”
More than three decades later, though, Col-
orado is still engaged in an ongoing battle to
decrease transmission rates. In 2015, Denver
joined more than 120 other communities in a
global effort to end HIV called the Fast-Track
Cities initiative. The group’s goal is to accom-
plish the feat of no new transmissions by 2030.
By 2020, however, local officials are aiming to
achieve a 90-90-90 goal across the five-county
metro area—90 percent of people with the
disease being diagnosed, 90 percent of those
diagnosed being engaged in care, and 90 percent
of those engaged in care living with suppressed
viral loads. According to a 2018 report put out
by the Denver task force, the numbers were at 87
percent, 81 percent, and 90 percent, respectively.
Those stats aren’t necessarily bad, but they’re
not as impressive as the numbers some other cit-
ies are attaining. San Francisco, for example, is a
leader in the race to end HIV. There are roughly
16,000 people living with HIV in the City by the Bay, making it one
of the largest HIV-positive populations in the country. Since 2013,
the city’s annual number of new transmissions has decreased from
394 to a preliminary 2018 figure of 190, a steep decline compared
with those of other cities nationwide. One decision that has helped
San Francisco break trail is that the city, in 2010, became an early
adopter of treating patients the moment they’re diagnosed—years
before that practice was incorporated into the national guidelines.
(The standard used to be to wait for signs of immune damage in a
patient before beginning treatment.) “They’ve done a good job get-
ting as many people on medication as possible,” Rowan says.
In addition to combating HIV, American cities and states are
also contending with jumps in more common sexually transmit-
ted infections (STIs)—namely, chlamydia, gonorrhea, and syphilis.
Greenberg used the word “skyrocketed” when asked about the recent
STI increases in the Denver metro area. Indeed, from 2013 to 2017,
the Colorado Department of Public Health and Envi-
ronment (CDPHE) saw a 43 percent increase in the
overall rate of those three STIs. In 2017 alone, there were
more than 36,000 new cases in the state. The numbers,
says Dr. Daniel Shodell, deputy director of the disease
control and environmental epidemiology division at
Dr. Ken Greenberg sees
patients living with the disease
at the Rocky Mountain CARES
HIV clinic in Denver.
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PHOTOGRAPHY BY CALEB ALVARADO